Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03025 | Date 02/11/2022 |
| Token No | SM/25-26/9114 15/10/2025 | Serial | 003 |
| Patient Name | Mrs. KALO BIBI | Contact No | 8100606877 |
| Address | GUMODANGA MOLLABER 712250 | Age | 68 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||